Individual provider Active NPI

Sue A Stucker, NP

  • Family Nurse Practitioner
  • Syracuse, NY
National Provider Identifier
1346584034
Registry record updated Dec 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F338786 Issued in NY
Practice address
182 Intrepid LN
Syracuse, NY 13205-2545
Phone
(315) 218-7020
NPI assigned
Nov 19, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 534902-1 NY
Family Nurse Practitioner 363LF0000X F338786 NY Primary

Addresses

Primary practice location

182 Intrepid LN
Syracuse, NY 13205-2545

Mailing address

182 Intrepid LN
Syracuse, NY 13205-2545
Phone (315) 218-7020

Other identifiers 2

IdentifierTypeStateIssuer
534902-1OtherNYRN
F338786OtherNYNP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150205001829 NY Practitioner - Nurse Practitioner 8527383926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Familycare Medical Group PCGroup PAC ID 5193639565, 110 clinicians

Practice addresses (Care Compare)

1001 W Fayette St
Suite 400
Syracuse, NY 13204-2866
Phone (315) 472-1488

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
534902-1NYMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Familycare Medical Group, PC CurrentSince Aug 1, 2014 Accepting new patients

Locations

4 Gertrude Dr
Central Square, NY 13036
Phone (315) 668-3910

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

182 Intrepid Ln
Syracuse, NY 13205
Phone (315) 218-7020

Interoperability endpoints

  • Direct secure messaging: sstucker@fcmg.medentdirect.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1346584034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "182 INTREPID LN",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132052545",
            "telephone_number": "315-218-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 INTREPID LN",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132052545",
            "telephone_number": "315-218-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUCKER",
        "first_name": "SUE",
        "middle_name": "A",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-19",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "534902-1",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F338786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN",
            "identifier": "534902-1",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NP",
            "identifier": "F338786",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.